Covolo Elisa, Saia Francesco, Napodano Massimo, Frigo Anna Chiara, Agostoni Pierfrancesco, Mojoli Marco, Fraccaro Chiara, Ciuca Cristina, Presbitero Patrizia, Moretti Claudio, D'Ascenzo Fabrizio, Tarantini Giuseppe
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Department of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
Am J Cardiol. 2015 Mar 15;115(6):810-5. doi: 10.1016/j.amjcard.2014.12.042. Epub 2015 Jan 6.
A relevant proportion of patients, classified as severe aortic stenosis on the basis of valve area ≤1 cm(2), have a mean transvalvular gradient ≤40 mm Hg, despite a preserved left ventricular ejection fraction (LGSAS). We assessed the clinical and hemodynamic impact of transcatheter aortic valve implantation in patients with symptomatic LGSAS at high risk for surgery or inoperable, according to the type of percutaneous valve implanted. Ninety-five patients received an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California) and 51 received a Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota). The hemodynamic performance of the 2 valves was similar in term of final transvalvular gradients (10 mm Hg, p = 0.069). Early mortality rate was 7% and was not different between the 2 valves (p = 0.73). During follow-up, cardiovascular mortality rate was similar between groups, and valve type was not a predictor of outcome (p = 0.72). Estimated survival by Kaplan-Meier at 2 years was 70%. At multivariate analysis, life-threatening or major bleeding, postprocedural aortic insufficiency, and acute kidney injury were the major predictors of an adverse outcome. In patients with LGSAS treated by transcatheter aortic valve implantation, the use of balloon-expandable versus self-expandable valves resulted in similar hemodynamic, early, and long-term clinical outcomes.
相当一部分患者，基于瓣膜面积≤1平方厘米被归类为重度主动脉瓣狭窄，尽管左心室射血分数保留，但平均跨瓣压差≤40毫米汞柱（低梯度重度主动脉瓣狭窄，LGSAS）。我们根据植入的经皮瓣膜类型，评估了经导管主动脉瓣植入术对有症状的、手术高风险或无法手术的LGSAS患者的临床和血流动力学影响。95例患者接受了爱德华SAPIEN瓣膜（爱德华生命科学公司，加利福尼亚州欧文），51例患者接受了美敦力CoreValve瓣膜（美敦力公司，明尼苏达州明尼阿波利斯）。两种瓣膜的最终跨瓣压差方面的血流动力学表现相似（10毫米汞柱，p = 0.069）。早期死亡率为7%，两种瓣膜之间无差异（p = 0.73）。随访期间，两组间心血管死亡率相似，瓣膜类型不是预后的预测因素（p = 0.72）。根据Kaplan-Meier法估计的2年生存率为70%。多因素分析显示，危及生命或大出血、术后主动脉瓣关闭不全和急性肾损伤是不良预后的主要预测因素。在接受经导管主动脉瓣植入术治疗的LGSAS患者中，使用球囊扩张式瓣膜与自膨胀式瓣膜导致相似的血流动力学、早期和长期临床结果。
